Provider Demographics
NPI:1407208390
Name:CLEAR MIND THERAPY LLC
Entity Type:Organization
Organization Name:CLEAR MIND THERAPY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:712-256-9902
Mailing Address - Street 1:300 W BROADWAY STE 706
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-4489
Mailing Address - Country:US
Mailing Address - Phone:712-256-9902
Mailing Address - Fax:712-256-9903
Practice Address - Street 1:300 W BROADWAY STE 706
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4489
Practice Address - Country:US
Practice Address - Phone:712-256-9902
Practice Address - Fax:712-256-9903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001147101YM0800X
IA0077631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty